Treatment of Zenker’s diverticulum using a novel grasping-type scissors forceps allows fast, safe, and effective endoscopic diverticulotomy
submitted 18. September 2017
accepted after revision 13. März 2018
25. Mai 2018 (online)
Background and study aims Although several endoscopic techniques have been described for Zenker’s diverticulotomy, no standardized endoscopic approach has been established in clinical routine to date. This study aimed to assess the efficacy and safety of endoscopic diverticulotomy using the Clutch Cutter.
Patients and methods Cricopharyngeal myotomy was performed in six prospectively enrolled patients with symptomatic Zenker’s diverticulum, using the Clutch Cutter. Procedural details such as duration, complications, and technical success were recorded and compared to the outcomes of 15 patients who received needle-knife-based myotomy.
Results Myotomy with the Clutch Cutter was feasible in all six patients with complete diverticulotomy in a single session in all patients. Mean procedure time of the Clutch Cutter myotomy was 19 minutes without major complications. During follow-up, one patient had diverticulum recurrence after 10 months, which was successfully re-treated. Mean procedure time with the needle-knife was 43 minutes and a mean of 2.7 myotomy sessions was required for complete diverticulotomy.
Conclusion Endoscopic diverticulotomy using the Clutch Cutter is safe, effective, and fast. Larger studies comparing myotomy using the Clutch Cutter with other endoscopic techniques are highly warranted.
- 1 Cook IJ, Gabb M, Panagopoulos V. et al. Pharyngeal (Zenker’s) diverticulum is a disorder of upper esophageal sphincter opening. Gastroenterology 1992; 103: 1229-1235
- 2 Ferreira LE, Simmons DT, Baron TH. Zenker’s diverticula: pathophysiology, clinical presentation, and flexible endoscopic management. Dis Esophagus 2008; 21: 1-8
- 3 Pech O. Esophageal disease. Endoscopy 2013; 45: 729-733
- 4 Rabenstein T, May A, Michel J. et al. Argon plasma coagulation for flexible endoscopic Zenker’s diverticulotomy. Endoscopy 2007; 39: 141-145
- 5 Wahab PJ, Mulder CJ, den Hartog G. et al. Argon plasma coagulation in flexible gastrointestinal endoscopy: pilot experiences. Endoscopy 1997; 29: 176-181
- 6 Christiaens P, De Roock W, Van Olmen A. et al. Treatment of Zenker’s diverticulum through a flexible endoscope with a transparent oblique-end hood attached to the tip and a monopolar forceps. Endoscopy 2007; 39: 137-140
- 7 Costamagna G, Iacopini F, Tringali A. et al. Flexible endoscopic Zenker’s diverticulotomy: cap-assisted technique vs. diverticuloscope-assisted technique. Endoscopy 2007; 39: 146-152
- 8 Repici A, Pagano N, Romeo F. et al. Endoscopic flexible treatment of Zenker’s diverticulum: a modification of the needle-knife technique. Endoscopy 2010; 42: 532-535
- 9 Rivory J, Almahayawi A, Roman S. et al. Endoscopic Zenker diverticulotomy using the window technique: a technical trick to improve the field of view. Endoscopy 2016; 48 (Suppl. 01) E63-64
- 10 Sakai P, Ishioka S, Maluf-Filho F. et al. Endoscopic treatment of Zenker’s diverticulum with an oblique-end hood attached to the endoscope. Gastrointest Endosc 2001; 54: 760-763
- 11 Vogelsang A, Preiss C, Neuhaus H. et al. Endotherapy of Zenker’s diverticulum using the needle-knife technique: long-term follow-up. Endoscopy 2007; 39: 131-136
- 12 Akahoshi K, Akahane H, Murata A. et al. Endoscopic submucosal dissection using a novel grasping type scissors forceps. Endoscopy 2007; 39: 1103-1105
- 13 Akahoshi K, Honda K, Akahane H. et al. Endoscopic submucosal dissection by using a grasping-type scissors forceps: a preliminary clinical study (with video). Gastrointest Endosc 2008; 67: 1128-1133
- 14 Neumann H, Loffler S, Rieger S. et al. Endoscopic therapy of Zenker’s diverticulum using a novel endoscopic scissor - the Clutch Cutter device. Endoscopy 2015; 47 (Suppl. 01) E430-431
- 15 Brombart M. [Zenker’s pharyngo-esophageal diverticulum; pathogenic considerations on radiological studies on 26 cases (23 cases in initial stage)]. J Belge Radiol 1953; 36: 166-197
- 16 Huberty V, El Bacha S, Blero D. et al. Endoscopic treatment for Zenker’s diverticulum: long-term results (with video). Gastrointest Endosc 2013; 77: 701-707